AAMFT California Newsletter Summer 2013
This issue completes the first year of AAMFT-CA eNewsletter. Thank you. The success of the newsletter was not possible without your interest and support. In this issue we correct an editing mistake and extend our apologies to Kate Wilson. On behalf of the editing team, we humbly extend our apologies to Kate for the error, and hope she enjoys seeing the correction as much as you enjoy reading her article–we did.
As always, we are interested in hearing from our members and readers. Your feedback and support ensures our newsletter is an exceptional tool that can take you into the future. Should you wish to contribute to the future success of our newsletter or profession, forward your comment(s), idea(s), or article title(s) to me here.
David Clark, MA
AAMFT-CA Exec. Director Update
Great News for Mental Health in California
Olivia Loewy, PhD
As Good as it Gets
On June 10, 2013, the California legislature passed a budget that included $206.2 million to expand community based mental health. Put in a larger context, with no surplus in the California state budget, support for mental health prevailed. In fact, we were the only ones who prevailed.
For this triumph, we must give credit to Senate President Pro Tem Darrell Steinberg, who has long been our champion in the Sacramento legislature. Co-author of Proposition 63 in 2004, then-Assemblyman Steinberg was next elected to serve in the state Senate and presently has only one year remaining in office. With the California budget stabilized, Senator Steinberg has affirmed that he can now turn his attention back to his priority as a legislator: mental health.
The new funds have been allocated as follows:
1. Investment in Mental Health Wellness
A $142.5 million one-time general fund to expand community-based mental health service capacity to address short-term, acute needs, and ongoing treatment and rehabilitation services for people by:
(a) Adding 25 mobile crisis teams
(b) Expanding by at least 2,000 Crisis Stabilization and Crisis Residential Treatment Beds; and
(c) Adding 600 triage personnel to assist people with needs with services.
Although one-time, it is anticipated that these funds will be sustained by savings.
2. Expanded Medi-Cal Benefits for Mental Health and Substance Use Disorder Services
For existing and newly eligible under federal ACA, the Medi-Cal benefit package now includes mid-level mental health services and substance use disorder services in response to the federal ACA and its definition of essential health benefits.
In addition, beyond the recent budget allocations, Integrated Services for Mentally Ill Parolees (ISMIP) will be expanded through the counties. This shift from the prisons to the communities is already underway. The Mental Health Wellness funds will be able to assist in efforts to reduce recidivism by providing expanded and intense care to this population.
With Healthcare Reform implementation on the way, a severe mental health provider shortage is anticipated. We are expecting an immense increase in job opportunities for MFTs. However, just being educated and/or licensed isn’t enough to make you competitive in the emerging marketplace. You need to be specifically trained and prepared to provide services in the evolving systems of care.
What is AAMFT-CA Doing for You?
AAMFT-CA is working actively from two angles to secure a solid position for MFTs in the evolving systems of care: advocacy at the state policy level; development of relevant, updated training in coordination with county and community agency representatives.
State Policy Advocacy
We are trail blazing in California. There is a lot of opportunity for involvement at the state level as the new systems of care are being developed. Funding reforms as well as revisions in administrative procedures and documentation methods are being discussed. Regulations are being written and interpretation of those regulations is being deliberated. AAMFT-CA is participating in the discussions, along with our colleagues from the California Council of Community Mental Health Agencies, the California Institute for Mental Health and the California Coalition for Whole Health.
Most exciting for us is the creation of the Dual Eligible Pilot Projects in eight counties, which will be designed as integrative, comprehensive systems of care for those who are eligible to receive both Medi-Cal and Medicare services. Historically, MFTs have been left out of systems that serve this population because we are still not approved providers of Medicare Services. However, these emerging systems will be funded based on capitated rates and there is language in the MOU that gives health plans flexibility to use their capitation on beyond traditional Medicare-reimbursable services. We believe that this means MFTs – and we are taking steps to ensure that the health plans in California are knowledgeable about the valuable contributions that MFTs can make in these systems of care as well as aware of the regulatory language that permits them to hire us.
Education and Training
In the January 2013 Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues, SAMHSA stated: “…shortages of qualified workers, recruitment and retention of staff and an aging workforce have long been cited as problems”. To be a “qualified worker”, the knowledge and training of many providers will need to be updated as the SAMSHA report continues to state:
Major changes to the field include the integration of behavioral health and primary care, a push to accelerate the adoption of evidence-based practices, and a model of care that is recovery oriented, person-centered, integrated, and utilizes multi-disciplinary teams.
The AAMFT-CA strategic partnership with the California Council of Community Mental Health Agencies has provided the means for us to develop relevant, updated resources informed by county and community agency representatives, including:
The Transforming System: A Handbook for Understanding the Changes in California
Community Mental Health: a comprehensive and practical text that can be utilized by educators and supervisors to address the evolving changes in healthcare delivery systems.
The Transformed Supervisor: Clinical Supervision in California Public Mental Health: a one-day training course that provides guidance for clinical supervisors working with interns in Recovery-Oriented treatment settings.
Online certification programs:
- LGBT Affirmative Therapy Certification
- Substance Use Disorder Certification
Stay tuned for more, as we announce a new training course and the dates and locations of future regional Forums that will bring MFTs together with community agency reps and future employers to establish a direct line between training, education and “real life” in the communities.
This truly is our time! Many new professional pathways are lining up at the feet of MFTs–AAMFT-CA is planning to do whatever we can to support your journey.
Olivia Loewy, PhD is Executive Director of AAMFT-CA. She can be reached at firstname.lastname@example.org.
Image source: Courtesy of Olivia Loewy, PhD
RULING EXPECTED SOON ON REPARATIVE THERAPY BAN
Benjamin E. Caldwell, PsyD
Following the Supreme Court’s historic rulings on the Defense of Marriage Act and Proposition 8, we are awaiting one more significant court ruling related to the treatment of gays and lesbians in California. We soon will know whether the state’s ban on therapies to change the sexual orientation of minors can take effect.
Senate Bill 1172 California’s ban on reparative therapy for minors (also known as conversion therapy, sexual orientation change efforts, or more simply, SOCE), was signed into law last year with AAMFT-CA’s active involvement and support. It was immediately challenged in court, and has not taken effect pending a ruling from the Ninth Circuit Court of Appeals.
If the court allows the law to stand, practicing a therapy intended to change a minor’s sexual orientation would be considered unprofessional conduct. A licensed or registered therapist who attempted such treatment would be subject to discipline against their license. This builds in a religious exemption to the law, as those who practice with a congregation as part of their religious duties are exempt from licensure requirements.
AAMFT-CA was the lead co-signer of an amicus brief in the case, joined by NASW-California and the California Psychological Association. The Court sought additional briefings from both sides of the dispute in May, and has not indicated specifically when its final ruling will be available. Other states are watching the California case closely: New Jersey is moving forward with a bill modeled after 1172, and a New York lawmaker has announced similar plans there.
Benjamin E. Caldwell, PsyD chairs the AAMFT-California Division Legislative and Advocacy Committee. He can be reached at email@example.com.
Image source: Courtesy of Ben Caldwell, PsyD
MFT OUTCOME-BASED EDUCATION
Stephen W. Brown, PhD, JD
Social, economic, legal and professional concerns have led MFT, and other health professions, to move to a competency based model of education and training called Outcome-Based Education (O-B) (Gehart, 2011). Traditional professional education, called Input-Based Education (I-B), focused primarily on the satisfactory completion of specific classes and a specified number of supervised training activities. O-B education, on the other hand, focuses on the specific measurable knowledge and skill competencies that program graduates need to achieve. This move towards outcome based education has a long history (e.g., Bloom, 1956, Nelson, 2005) however, since the publication of the AAMFT Core Competencies (2002) and the Version 11 of the COAMFTE Accreditation Standards (2005) O-B has become the primary focus of MFT curricula.
In moving towards an outcome-based education, an MFT program starts by developing its desired Program Outcomes, POs, (e.g., Program graduates will be competent to deliver professional MFT services independently). The program then needs assurances that its faculty is competent to facilitate the achievement of the POs. This requires the development of measureable Faculty Outcomes, FOs, (e.g., the faculty is competent to teach and train students in the practice of MFT). Finally, the program needs to develop specific measureable Student Learning Outcomes, SLOs, (e.g., Students demonstrate the ability to deliver family therapy effectively). MFT programs develop multiple POs, FOs and SLOs. These different outcomes must be consistent with each other and they need to reflect the overall mission of the program’s university or college.
After POs, FOs and SLOs have been developed, the program needs to identify measures that will assess and operationally define the achievement of each PO, FO and SLO. Following the examples above, a measure or operational definition of the PO “being competent to deliver MFT services independently” might be “passing the state license examination.” Similarly, “having faculty who have been licensed MFTs for at least five years” could be an operational definition of the FO of having a faculty competent to teach and train MFT practice skills. “The rating a practicum supervisor assigns to a student’s MFT family therapy skills” could be an operational measure of the SLO of a student’s competence in delivering family therapy. It should be noted that each outcome will have at least one and usually more than one measure (operational definition) of its achievement.
Next, the program needs to establish benchmarks that are the specific measurement standards that the program hopes to achieve. Benchmark achievements inform all stakeholders, about the program’s success and about the areas in which improvements are needed. A benchmark for the PO example might be “90% of the program graduates who take the state licensing exam will pass on their first attempt.” A possible sample FO benchmark might be “At least 80% of the faculty will be licensed as an MFT for at least five years.” While a benchmark for the example SLO might be “At least 90% of the students will receive practicum supervisor ratings of satisfactory or higher on their ability to deliver family therapy services.” A separate benchmark is established for each of the different outcome measures.
After spending considerable time developing and refining POs, FOs and SLOs, the program then implements the outcome-based educational program through an ongoing process of developing syllabi, constructing specific educational activities, designing measures and writing rubrics to teach its students and assess its benchmark achievements. If the program is achieving its benchmarks, this is evidence that the program is effectively achieving its desired outcomes. If the program is not achieving its benchmarks, then the program needs to develop and implement plans to improve outcome achievement. In addition to evaluating benchmark achievement, MFT educational programs also regularly assess their outcomes to make sure they are consistent with the program’s values and that they reflect cutting edge developments within the profession.
O-B education is not just adding operational outcome measures and benchmarks to the IB education process. Rather, it is a systemic transformation in which each class or experience needs to have measurable outcomes, the instructional process needs to identify activities to facilitate the achievement of these outcomes and rubrics need to be developed to actually measure outcome attainment.
The overall goal of O-B is to improve the services being delivered by MFT professionals. Research evidence supports that this is in fact occurring in clinical psychology and other disciplines (Spring & Neville, 2011). Further research is needed to document this finding in our profession.
Stephen Brown, PhD, JD is a professor at the CFT Program as well as Systemwide Coordinator of CFT Education Outcomes for Alliant International University, California School of Professional Psychology. He may be reached at firstname.lastname@example.org.
For references to this article, click here.
SURVIVING THE DOCTORAL PROGRAM
Kate Wilson, MA, PsyD Student
One of the scariest times in my life was deciding whether to earn a Master’s or Doctoral degree. There are so many questions to answer, for example: Should I enroll in a cohort or individual program model? How will my social life be affected? What benefits might I experience with a Doctoral degree versus a Master’s degree? What financial considerations must I account for? As I write this I’m currently in the 4th year of a Psychology Doctoral program, and share what I found to be true for myself and students in Doctoral programs at my university. Throughout this time I’ve come to learn that I’m surviving quite well and my family is amazingly resilient. There are, however, tidbits of information that would have helped greatly to ease anxiety in the beginning of my journey, some of which I share with you here.
When I considered a Doctoral program I had thought that my social life would suffer. I discovered through the cohort model that my life became incredibly enriched by the meaningful friendships I made. My classmates are people I bonded with over laughter and tears. The friendships enriched my social life more than I had ever imagined, and afforded me more friendships than ever before. Additionally, my experience has been fortunate in that I have met and bonded with students from diverse populations. From them I have learned as much as I have from those charged with my instruction at the Master’s and Doctoral level.
Oftentimes, people will ask why I didn’t stop at the Master’s level or why I am bothering with a Doctorate. I typically respond by citing the greater opportunity available with a Doctoral degree. For those of us interested in management, teaching, specialties, and research, a Doctoral degree will allow for a greater likelihood of these aspirations. However, there are a number of placements for those with a Master’s degree and licensure. Alternatively, my experience has been that finding an internship site that can accommodate the requirements of a Doctoral student can be difficult. Persistence and an open mind can help greatly in finding a site, so don’t be afraid to network out of your comfort zone. For example, volunteering for a professional organization can greatly increase your visibility to potential employers and internships that offer an income.
Of course, financial considerations must be made. Paying for graduate school is no cheap adventure. When I investigated graduate schools I realized that after paying tuition, books, others supplies, and basic living expenses, I was looking at what amounted to a down payment on a very nice home, and in some places the price of a home itself. Financial aid forms were easy to complete, but I strongly also recommend looking for stipends and grants to help pay your way. A cost I had to discuss with my partner was the toll on my family life. With a teen and young adult children to consider in the equation, determining how to rearrange responsibilities and time to spend with my children has been challenging at times. I was concerned that working toward a Doctoral degree could cause us to become alienated. However, through the program the most surprising and valuable benefit I’ve been afforded is personal growth. The support of my cohort and instructors engendered an environment that increased my academic knowledge as well as refined my emotional intelligence. Greater understanding helped me better connect with my family, and I believe has helped my family grow as well. Emotional growth is an asset that cannot be priced. Thus, I focus on the intangible benefits knowing I will be able to manage the tangible costs of a Doctoral degree.
Of course, your experience may significantly differ from mine, so be sure to consider interviewing others in different Doctoral programs and answer questions specific to your circumstances to make an informed decision. Most important of all, don’t forget to take care of yourself.
Kate Wilson, Marriage and Family Therapist Registered Intern is enrolled the PsyD program at the Alliant International University, California School of Professional Psychology. She may be reached at email@example.com
Image source: Courtesy of Kate Wilson, M.A.
Book Reviewers Needed: Beginning with our next issue will be including reviews of recent books of interest to MFT. If you would be interested in reviewing books for this newsletter please send an email to Steve Brown at firstname.lastname@example.org.
What Therapists Need to Know to Survive the DSM-5 A Preview of What’s New & Different (Santa Monica/West LA)
The DSM-5: What You Need to Know (Chatsworth)
Law and Ethics Update: What’s New, and What’s Next (Sacramento)
November 1 & 2
Open Membership Meeting (Hayward)
Incorporating Recovery-Oriented Care in Clinical Work (Inland Empire)
AAMFT-CA Division 4th Annual Student Research Conference (San Francisco)
AAMFT-CA First Annual Fund Raiser
AAMFT-CA FIRST ANNUAL FUNDRAISER 2013
Olivia Loewy, PhD
On June 30, 2013, the AAMFT-CA Division held its first-ever fund raiser at the Los Angeles Tennis Club in Hancock Park. The event focused on acknowledgement of the work of three honorees who were each presented with an award:
Diane Gehart, PhD, MFT. A professor of Marriage and Family Therapy at California State
University, Northridge, she has authored several books, including Mastering Competencies in Family Therapy, written numerous professional articles and is an internationally sought after speaker. She is on the editorial review boards for several academic journals as well as community service boards related to child sexual abuse.
Nancy Steiny, PhD, MFT. A past Executive Director of the Southern California Counseling Center, who, over many years, has trained and supervised thousands of trainees, interns and paraprofessionals, as well as hundreds of supervisors through her AAMFT Approved Supervision trainings. She holds an honorary Doctorate from CSPP where she served as Board chair for 8 years. Additionally she has served on the Boards of SCCC and CAMFT.
Senator Ted Lieu Ted was a leader in standing up to Wall Street excesses, reforming the subprime mortgage industry, increasing green buildings, reducing global warming, protecting public safety, and preventing domestic violence. Ted has repeatedly stood up to powerful interests on behalf of consumers, crime victims, seniors, children, and those without a voice.
Sen. Lieu’s patient-protection plan makes California the first state in the nation to end the psychological abuse of children through unethical treatments that falsely promise to change a minor’s sexual orientation.
The AAMFT-CA Division Board of Directors was very pleased with the turnout, enthusiasm and support that confirmed and encouraged the Division’s leadership efforts. All Board members and volunteers, under the direction of Treasurer Ralph Bruneau, worked very hard to make this first venture a success.
Award Recipients Senator Ted Lieu, Dr. Diane Gehart and Dr. Nancy Steiny with AAMFT-CA
Division Board President Norma Scarborough and Executive Director Olivia Loewy.
For more photos of this event click here.
Olivia Loewy, PhD is Executive Director of AAMFT-CA. She can be reached at email@example.com.
American Association for Marriage and Family Therapy. (2004). Marriage and family therapy core competencies. Alexandria, VA: Author.
Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., & Krathwohl, D. R. (1956). Taxonomy of educational objectives: the classification of educational goals; Handbook I: Cognitive Domain. New York: Longmans, Green.
Commission on the Accreditation of Marriage and Family Therapy Education. (2005).
Accreditation Standards Version 11. Retrieved on 6/29/2013 from http://www.aamft.org/imis15/Documents/Accreditation_Standards_Version_11.pdf
Gehart, D. (2011). The core competencies and MFT education: Practical aspects of transitioning to a learning-centered, outcome-based pedagogy. Journal of Marital and Family Therapy, (37)3 p. 344–354 doi: 10.1111/j.1752-0606.2010.00205.x
Nelson, T. S. & Smock, S, A. (2005). Challenges of an Outcome-Based Perspective for Marriage and Family Therapy Education. Family Process. (44)3, p355-362. doi: 10.1111/j.1545-5300.2005.00064.x.
Spring, B. & Neville, K. (2011) Evidence-based practice in psychology in Barlow, D. H. (Ed.); The Oxford Handbook of Clinical Psychology. pp. 128-149. New York, NY, US: Oxford University Press.